Drugs & Aging最新文献

{"title":"Managing Rheumatoid Arthritis in Older Adults with Cancer.","authors":"Maria A Lopez-Olivo, Aliza R Karpes Matusevich, Jean H Tayar, Huifang Lu","doi":"10.1007/s40266-025-01214-4","DOIUrl":"https://doi.org/10.1007/s40266-025-01214-4","url":null,"abstract":"<p><p>Rheumatoid arthritis (RA) is a chronic autoimmune condition disproportionately affecting older adults (> 60 years), who often experience increased disease severity and comorbidities, including cancer. A comprehensive review of the literature was conducted, examining the prevalence of malignancy in patients with RA, associated risk factors, and treatment challenges, including management considerations such as psychological distress and lifestyle modifications. Clinical guidelines and consensus statements were summarized to provide practical insights for optimizing care. Older adults with RA are at an elevated risk for developing cancer due to chronic inflammation, immunosenescence from aging, and shared risk factors such as smoking. Patients with RA tend to have poorer cancer survival rates than individuals without RA, particularly for lung cancer and lymphoma. Immunosuppressive therapies used to treat RA may modestly increase cancer risks but are critical for disease control. Current guidelines emphasize discontinuation or adjustment of RA therapies upon cancer diagnosis, with tailored approaches based on cancer type and stage. Non-pharmacologic interventions, including lifestyle modifications and psychological support, play a vital role in improving quality of life and mitigating disease flares during cancer treatment. The management of RA in older adults with a history of cancer requires a personalized, multidisciplinary approach that balances the need for RA symptom control without affecting cancer outcomes. Shared decision-making, incorporating patient preferences and comorbidities, is critical for optimizing care. Further research is needed to strengthen evidence-based guidelines for this population and address gaps in understanding treatment safety and efficacy.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Does not Affect the Efficacy of Antibody Drug Conjugates, But is Associated with High-Grade Adverse Events in Patients with Cancer Enrolled in Early Phase Clinical Trials.","authors":"Ana Vaz Ferreira, Matthieu Delaye, Arnaud Pages, Antoine Hollebecque, Anas Gazzah, Rastio Bahleda, Jean-Marie Michot, Francois-Xavier Danlos, Lauren Seknazi, Vincent Goldschmidt, Clémence Hénon, Madonna Sakkal, Cristina Smolenschi, Stéphane Champiat, Aurelien Marabelle, Yohann Loriot, Céline Nagera Lazarovici, Zoé Ap-Thomas, Geoffroy Beraud Chaullet, Santiago Ponce Aix, Christophe Massard, Kaissa Ouali, Maxime Frelaut, Capucine Baldini","doi":"10.1007/s40266-025-01212-6","DOIUrl":"https://doi.org/10.1007/s40266-025-01212-6","url":null,"abstract":"<p><strong>Background: </strong>Data on the use of antibody drug conjugates (ADCs) in older patients are scarce.</p><p><strong>Objective: </strong>The objective was to study the safety and efficacy of ADCs used in early phase clinical trials in patients aged ≥ 65 years compared with younger patients.</p><p><strong>Patients and methods: </strong>All patients enrolled in early phase clinical trials (phase I or II) of ADCs for solid tumors in our institution between November 2014 and May 2023 were included in this retrospective monocentric study. Safety and efficacy were compared between patients ≥ 65 and < 65 years old (y.o).</p><p><strong>Results: </strong>A total of 136 patients were included in our study, with 43 (31.6%) patients aged ≥ 65 y.o. In comparison with the younger population, patients aged 65 years or older had similar demographic characteristics. Older patients experienced the same rate of all-grade adverse events (95.3 versus 97.8%) and all-grade related adverse events (65.1 versus 66.7%) but more high-grade adverse events (41.9 versus 30.1%) than younger patients. In the univariate analysis, we identified age, taken as a continuous variable, as associated with high-grade adverse event (p = 0.047). No statistically significant difference was found between older and younger patients in terms of disease control rate (65 versus 54%), median progression-free survival (2.76 months [95% confidence interval, 95% CI 1.64-3.75] compared with 2.56 [95% CI 1.81-2.79], p = 0.34), or median overall survival (6.57 months [95% CI 4.01-13.01] compared to 7.89 [95% CI 6.83-9.36], p = 0.65).</p><p><strong>Conclusions: </strong>In our cohort, ADC therapy provided comparable survival benefits for the older patients but with a higher risk of high-grade adverse event.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination Pharmacotherapy for Benign Prostatic Hyperplasia: Evaluation of Existing Literature on Combination Therapies for Lower Urinary Tract Symptoms Associated with BPH.","authors":"Joséphine Papet, Jean-Nicolas Cornu, Hugo Dupuis","doi":"10.1007/s40266-025-01198-1","DOIUrl":"https://doi.org/10.1007/s40266-025-01198-1","url":null,"abstract":"<p><strong>Objective: </strong>Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) significantly impact quality of life in aging men. While monotherapies, including alpha-blockers, 5-alpha reductase inhibitors (5-ARI), or phosphodiesterase type 5 inhibitors (PDE5i), are widely used, the potential benefits and risks of combination pharmacotherapies remain less well-documented. This study reviews and assesses the current evidence regarding the use of combination pharmacotherapies in the management of BPH-related LUTS to provide a comprehensive overview of their efficacy and safety profiles.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed, including randomized controlled trials (RCTs) published up to June 2024. Studies were selected on the basis of predefined inclusion criteria, focusing on clinical outcomes such as International Prostate Symptom Score (IPSS), urinary flow rate (Q_max), and quality of life. Data from 22 eligible studies were analyzed and summarized.</p><p><strong>Results: </strong>Combination therapies, particularly those involving alpha-blockers and 5-ARI, demonstrated significant reductions in clinical progression, improvements in urinary flow, and symptom relief compared with monotherapies. Therapies combining alpha-blockers with anticholinergics, beta-3 agonists, or phytotherapeutic agents showed potential for targeting mixed symptoms, though evidence remains limited. Triple therapy studies are scarce, with benefits observed only in highly symptomatic or refractory cases.</p><p><strong>Conclusions: </strong>Combination therapies for LUTS/BPH offer superior efficacy over monotherapy in certain cases, particularly with alpha-blockers and 5-ARI, which significantly reduce disease progression and symptoms. Other combinations, including alpha-blockers with anticholinergics, beta-3 agonists, or PDE5 inhibitors, provide potential benefits for patients with mixed symptom profiles, though evidence remains heterogeneous. The level of evidence among studies varies significantly, ranging from high-quality RCTs to lower-level observational data, requiring careful interpretation. While combination treatments improve outcomes, they also present challenges in adherence and side effects. A personalized and evidence-based approach is essential to optimize treatment selection and balance efficacy with tolerability.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription and Non-prescription Medication Pill Burdens and Their Associations with Health-Related Quality of Life in Older Adults: A Cross-Sectional Study.","authors":"Josephine M Vonderhaar, Michael E Ernst, Michelle A Fravel, Suzanne G Orchard, Alice J Owen, Robyn L Woods, Rory Wolfe, Nigel Stocks, Julia Gilmartin-Thomas","doi":"10.1007/s40266-025-01199-0","DOIUrl":"10.1007/s40266-025-01199-0","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy is associated with reduced health-related quality of life (HRQoL). This study explores the association between prescription and non-prescription medication pill burdens, independent of underlying morbidity, on HRQoL in an older adult population.</p><p><strong>Methods: </strong>Data from the final intervention year of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized trial in older adults from Australia and the USA, were analyzed cross-sectionally. Participants reported daily prescription and non-prescription pill counts at the final trial visit. HRQoL was assessed using the 12-Item Short-Form instrument (SF-12) and summarized into the physical component summary (PCS) score and mental component summary (MCS) score, where lower scores reflect poorer HRQoL. Multivariable regression, adjusted for covariates, was used to examine the relationships of categorized prescription and non-prescription pill counts with PCS and MCS separately.</p><p><strong>Results: </strong>15,165 participants responded to the question about prescription use and 15,727 for non-prescriptions (mean age = 80 years). Compared with non-users of prescription medications, lower mean PCS scores and larger reductions in scores were seen as prescription medication pill burden increased from 1-3, 4-6, 7-9, to ≥ 10 pills (- 1.7, - 4.5, - 7.6, and - 10.9, respectively, p < 0.001). A similar relationship, but of lesser magnitude, was observed with non-prescription medication pill burden, where the mean PCS was lower by - 0.2 for 1-3 pills (p = 0.494), - 1.8 for 4-6 (p < 0.001), and - 1.9 for ≥ 7 pills (p < 0.001), compared with non-users. No significant association was observed between prescription or non-prescription medication pill burdens and MCS.</p><p><strong>Conclusions: </strong>Prescription and non-prescription medication pill burdens are independently associated with reduced physical, but not mental, HRQoL in older adults.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"457-467"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit-Risk Assessment of Rivaroxaban in Older Patients With Nonvalvular Atrial Fibrillation or Venous Thromboembolism.","authors":"Paul P Dobesh, Albert A Volkl, Ákos Ferenc Pap, C V Damaraju, Bennett Levitan, Zhong Yuan, Alpesh N Amin","doi":"10.1007/s40266-025-01192-7","DOIUrl":"10.1007/s40266-025-01192-7","url":null,"abstract":"<p><strong>Background: </strong>Both bleeding and adverse ischemic events increase with age, compounding the benefit-risk balance of anticoagulants in older patients. We present analyses using benefit-risk methods to better understand the age-dependence of the benefit-risk profile of rivaroxaban in patients with nonvalvular atrial fibrillation (NVAF) or venous thromboembolism (VTE).</p><p><strong>Methods: </strong>Randomized controlled trial data from the ROCKET-AF (NVAF) and EINSTEIN DVT, EINSTEIN PE, EINSTEIN-Extension, and EINSTEIN CHOICE in (VTE) were used. For ROCKET-AF, benefits and risks were assessed with incidence rates for key thrombotic and bleeding endpoints and a net clinical benefit (NCB) measure. Cumulative incidences (estimated by the Kaplan-Meier method) were estimated at day 185 for EINSTEIN and EINSTEIN Extension and 1 year for EINSTEIN CHOICE. Incidence differences were calculated for the overall population and age subgroups of < 65, 65-75, and > 75 years.</p><p><strong>Results: </strong>In ROCKET-AF, rate differences in the composite NCB outcome (vascular death, stroke, myocardial infarction, fatal bleeding, critical organ bleeding, and non-CNS systemic embolism) favored rivaroxaban overall and by age < 65, 65-75, and > 75 years (-84, -25, -61, and -150 cases per 10,000 patient-years, respectively). In the pooled EINSTEIN DVT and EINSTEIN PE studies, cumulative incidence differences for the composite NCB outcome (recurrent VTE and major bleeding) were -103, 3, -105, and -544 per 10,000 patients, respectively. For extended VTE treatment with rivaroxaban versus placebo in EINSTEIN-Extension, NCB results were -536, -492, -556, and -601 per 10,000 patients, respectively. In the EINSTEIN CHOICE analysis, NCB favored rivaroxaban 20 mg versus aspirin (-284, -255, -339, and -338, respectively) and rivaroxaban 10 mg versus aspirin (-339, -328, -485, and -80, respectively).</p><p><strong>Conclusions: </strong>This analysis demonstrated a positive benefit-risk profile with rivaroxaban versus trial comparators in older patients with NVAF or VTE, with benefit-risk increasingly favoring rivaroxaban with increasing age.</p><p><strong>Clinical trial registration: </strong>http://ClinicalTrials.gov , identifiers: NCT00403767 (ROCKET-AF), NCT00440193 (EINSTEIN DVT), NCT00439777 (EINSTEIN PE), NCT00439725 (EINSTEIN Extension), and NCT02064439 (EINSTEIN CHOICE).</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"469-484"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Deprescribing Guidelines Did Not Impact Actual Practice in Deprescribing of Potentially Inappropriate Medications for Nursing Home Residents: An Interrupted Time Series Analysis.","authors":"Degefaye Zelalem Anlay, Kristel Paque, Bart Van den Eynden, Tinne Dilles, Joachim Cohen","doi":"10.1007/s40266-025-01197-2","DOIUrl":"10.1007/s40266-025-01197-2","url":null,"abstract":"<p><strong>Background: </strong>Deprescribing guidelines reduce the use of potentially inappropriate medications (PIMs) in trial settings; however, their real-world impact remains unclear. Therefore, this study assesses deprescribing trends and the impact of guideline publications (STOPPFrail, proton pump inhibitors [PPIs], and antipsychotics) on these trends among nursing home residents with limited life expectancy in Belgium.</p><p><strong>Methods: </strong>Deprescribing was assessed using linked healthcare reimbursement data for all residents aged 65 years and older who died between 2014 and 2019. In total, 15 PIMs from STOPPFrail version 1 were selected. Deprescribing was operationalized as discontinuing at least one PIM in the last 4 months of life among those who had been prescribed these medications chronically between 6-12 months prior to death. To identify changes in the trend of deprescribing, we employed a joinpoint linear regression model. We calculated the average quarterly percent change (AQPC) and 95% confidence intervals (CIs). In addition, we used autoregressive integrated moving average (ARIMA) modeling to explore the impact of publication of these guidelines on four commonly used PIMs: PPIs, antipsychotics, lipid modifying agents, and calcium.</p><p><strong>Results: </strong>Among 244,865 residents, 169,782 (69.3%) were chronically prescribed at least one PIM and 50,487 (29.7%) had at least one discontinued. The prevalence of deprescribing declined from 31.7 to 27.66% between the first quarter of 2014 and the fourth quarter of 2019, with an average quarterly percent change decline of - 0.47% (95% CI - 0.85, - 0.10). No joinpoints were identified, indicating a consistent linear trend with no interruptions or statistically significant shifts in the rate of change in deprescribing prevalence. ARIMA modeling found that the publication of deprescribing guidelines had no impact on deprescribing trends.</p><p><strong>Conclusions: </strong>Despite the high use of PIMs, and the publication of the STOPPFrail, PPI, and antipsychotic deprescribing guidelines, deprescribing rates remained low and even decreased. These findings emphasize the importance of implementation efforts that go well beyond guideline publications to effectively change deprescribing practices.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"485-499"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors and Moderators of Hospitalisation and Mortality in People with Dementia Using Antipsychotics: Systematic Review.","authors":"Timothy Josh D Tan, Edward C Y Lau, Trong H Le, Christine Y Lu, Sarah N Hilmer, Yun-Hee Jeon, Lee-Fay Low, Edwin C K Tan","doi":"10.1007/s40266-025-01202-8","DOIUrl":"10.1007/s40266-025-01202-8","url":null,"abstract":"<p><strong>Background and objectives: </strong>Antipsychotics are used to manage behaviours and psychological symptoms of dementia. While antipsychotics have been associated with increased risk of adverse outcomes, factors associated with these outcomes have been understudied. Thus, the aim of this study was to identify factors associated with risk of hospitalisation and mortality in older people living with dementia using antipsychotics.</p><p><strong>Methods: </strong>In total, four databases (Embase, Medline, PsycINFO and Web of Science) were searched from 2010 to 30 April 2024 using keywords and Medical Subject Heading (MeSH) terms related to dementia, older adults, antipsychotics and outcomes (hospitalisation or mortality). Studies including older adults (≥ 65 years) with dementia and extractable data on risk measures were eligible. Risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tools and narrative synthesis of results was performed.</p><p><strong>Results: </strong>Of the 4139 studies identified, 24 were included (Total N [patients] = 587,885) with the majority being cohort studies (N = 23). Antipsychotic-related factors associated with mortality risk included the type of antipsychotic (e.g. typical versus atypical, adjusted hazards ratio [aHR] 1.50, 95% confidence interval [CI] 1.10, 2.10), and dose (high versus low, relative increases ranging from 57 to 155%). Patient-related factors included age (aHR 1.05, 95% CI 1.01, 1.08) and concomitant use of medications (e.g. benzodiazepines, aHR 2.19, 95% CI 1.83, 2.63). Antipsychotic-related factors associated with hospitalisation risk included the type of antipsychotic (e.g. atypical verus typical, aHR 1.17, 95% CI 1.08, 1.27) and dose (high versus low, adjusted odds ratio [aOR] 1.19, 95% CI 1.09, 1.31). Patient-related factors included concomitant benzodiazepine use (aHR 1.55, 95% CI 1.29, 1.86), and new use compared with past use (aOR 3.07, 95% CI 2.84, 3.32).</p><p><strong>Conclusions: </strong>This review identified several factors associated with risks of hospitalisation and mortality in antipsychotic users with dementia. Clinicians should consider these risk factors when prescribing antipsychotics to people living with dementia.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"381-394"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Survival and Postoperative Complications in Older Patients with Intertrochanteric Fractures: Association with Polypharmacy-A Multicenter Retrospective Cohort Study.","authors":"Yasuhiko Takegami, Yusuke Osawa, Hiroto Funahashi, Takamune Asamoto, Hiroaki Ido, Keiji Otaka, Shinya Tanaka, Hiroshi Asai, Hiroyuki Yokoi, Shiro Imagama","doi":"10.1007/s40266-025-01194-5","DOIUrl":"https://doi.org/10.1007/s40266-025-01194-5","url":null,"abstract":"<p><strong>Introduction: </strong>Polypharmacy is common in older patients and associated with adverse outcomes. However, the association with outcomes in patients with intertrochanteric fractures remains unclear. This study aimed to investigate associations between polypharmacy and 1-year survival (primary outcome) and postoperative complications (secondary outcome), in older patients undergoing surgical treatment for intertrochanteric fractures.</p><p><strong>Patients and methods: </strong>This multicenter retrospective study initially identified 1864 patients who underwent surgical treatment for intertrochanteric fractures between 2016 and 2020. We excluded those aged < 65 years, with polytrauma, or with Charlson Comorbidity Index (CCI) > 3 or insufficient data. Patients were classified into polypharmacy (≥ 5 medications) and non-polypharmacy (< 5 medications) groups. We performed two analyses: (1) complete case analysis using 1:1 propensity score matching (498 pairs) with variables including age, sex, body mass index (BMI), CCI, residence before admission, fracture type, American Society of Anesthesiologists (ASA) physical status (PS), and Parker Mobility Score, followed by Kaplan-Meier survival analysis with log-rank test and chi-squared test for complications and (2) multivariate Cox regression analysis using multiple imputation (CART method, five imputed datasets) of the eligible cohort (N = 1608), adjusting for the same variables.</p><p><strong>Results: </strong>In the matched cohort, the 1-year survival rate was significantly lower in the polypharmacy group (91.3%; 95% CI 87.7-93.8) compared with the non-polypharmacy group (94.0%; 95% CI 90.9-96.1; P = 0.027). Postoperative complications showed no significant differences between groups. Cox regression analysis revealed that advanced age, male sex, ASA-PS, and polypharmacy were associated with decreased survival, while higher Parker Mobility Score and normal and higher BMI showed improved survival.</p><p><strong>Conclusions: </strong>Polypharmacy was associated with lower postoperative survival in older patients with intertrochanteric fractures and few comorbidities. As a potentially modifiable factor, medication review through multidisciplinary collaboration might contribute to improved outcomes.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":"42 5","pages":"435-444"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Considerations for Severe Osteoporosis in Older Adults.","authors":"Heidi See, Emma Gowling, Evie Boswell, Pritti Aggarwal, Katherine King, Nicola Smith, Stephen Lim, Mark Baxter, Harnish P Patel","doi":"10.1007/s40266-025-01205-5","DOIUrl":"https://doi.org/10.1007/s40266-025-01205-5","url":null,"abstract":"<p><p>Osteoporosis, a chronic metabolic bone disease, increases the predisposition to fragility fractures and is associated with considerable morbidity, high health care cost as well as mortality. An elevation in the rate of incident fragility fractures will be observed proportional with the increase in the number of older people worldwide. Severe osteoporosis is currently defined as having a bone density determined by dual-energy X-ray absorptiometry that is more than 2.5 standard deviations (SD) below the young adult mean with one or more past fractures due to osteoporosis. Nutrition, physical activity and adequate vitamin D are essential for optimal bone strength throughout life. Hormone (oestrogen/sex steroid) status is also a major determinant of bone health. This review explores mechanisms involved in bone homeostasis, followed by the assessment and management of severe osteoporosis, including an overview of several treatment options in older people that range from anti-resorptive to anabolic therapies.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":"42 5","pages":"395-412"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms of Orthostatic Hypotension and Drugs Affecting Autonomic Function are Associated with the Onset of Frailty in Community-Dwelling Persons Aged 80 Years and Above: A Prospective Observational Study.","authors":"Aziz Debain, Fien Loosveldt, Veerle Knoop, Axelle Costenoble, Jordy Saren, Mirko Petrovic, Ivan Bautmans","doi":"10.1007/s40266-025-01200-w","DOIUrl":"10.1007/s40266-025-01200-w","url":null,"abstract":"<p><strong>Background: </strong>Both autonomic dysfunction and frailty are common and complex geriatric syndromes with similar negative health outcomes. Both conditions are characterized by a loss of homeostasis that makes individuals more vulnerable to stressors.</p><p><strong>Aim: </strong>The primary aim of this study is to examine the association between drugs that affect autonomic function and frailty onset in community-dwelling octogenarians. The secondary aim is to investigate the relationship between autonomic dysfunction and frailty onset in this population.</p><p><strong>Methods: </strong>In total, 372 nonfrail adults aged 80 years and above (mean age 83 ± 3 years) from the BUTTERFLY project were prospectively followed for 2 years (mean follow-up of 22 ± 6 months). The association between autonomic dysfunction (defined as neurogenic orthostatic hypotension and symptoms of orthostatic hypotension), the use of medications affecting autonomic function, and frailty status were examined using binary logistic regression analysis.</p><p><strong>Results: </strong>The completely adjusted binary logistic regression model showed that the use of drugs affecting autonomic function was associated with frailty {adjusted odds ratio (aOR) = 1.78 [95% confidence interval (CI) 1.06-3.00], p = 0.030}. Furthermore, symptoms of orthostatic hypotension were related to frailty (aOR = 2.98 [95% CI 1.13-7.88], p = 0.027).</p><p><strong>Conclusions: </strong>Our results show that symptoms of orthostatic hypotension and the use of drugs that affect autonomic function are accompanied with respectively 3-fold and 1.8-fold higher odds of frailty onset in persons aged 80 years and over. Therefore, pharmacological treatment that affects autonomic function should be started with caution and timely discontinued in older persons.</p>","PeriodicalId":11489,"journal":{"name":"Drugs & Aging","volume":" ","pages":"445-456"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}